Is indoor dining safe? Five health experts weigh in.

The social isolation and economic fallout is real. But so is the risk of transmission.

This story originally featured on The Conversation.

Earlier this fall, many of the nation’s restaurants opened their doors to patrons to eat inside, especially as the weather turned cold in places. Now, as COVID-19 cases surge across the country, some cities and towns have banned indoor dining while others have permitted it with restrictions. Still other geographies have no bans at all.

The restaurant and hospitality industry has reacted strongly, filing lawsuits challenging indoor dining bans and, in New York state, pointing to data that showed restaurants and bars accounted for only 1.4% of cases there—far lower compared with private gatherings.

We asked five health professionals if they would dine indoors at a restaurant. Four said no—and one had a surprising answer.

Not an option

Laurie Archbald-Pannone, Associate Professor of Medicine, University of Virgina

No.

March 12, 2020 was the last day I ate indoors at a restaurant. At the time, there was mild apprehension—but much changed that week. The COVID-19 pandemic altered many aspects of “normalcy,” and for me eating inside at a restaurant is one of those activities. I loved eating out and typically would eat out three times a week (sometimes more!). But understanding how the COVID-19 infection is transmitted, I feel that being inside without a mask on—even just to eat—is not an option for me. I strongly believe that we need to support our community through these challenging times, so we still get curbside pickup or delivery from our favorite local restaurants at least three times a week (sometimes more!) But it will be a while before I’m back inside. When I do return I’m definitely getting dessert.

Great risk

Thomas A. Russo, Chief of Infectious Disease Division, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo

No. And it’s been “no” right from the beginning.

We have a little more information now, but what I said in the spring hasn’t really changed. The greatest risk of getting infected with SARS-CoV-2 is being indoors with people who aren’t using masks at all times. The concern isn’t just big respiratory droplets when close to someone talking; it’s also the tiny aerosols that linger in the air.

Making it even riskier is the generally poor ventilation in many restaurants. The key differences between indoor dining and shopping in a big box store or grocery store are: 1) big stores have more ventilation and greater air space; 2) everyone can wear a mask at all times; 3) you’re not fixed in space, so if you see someone who just has a bandana or their mask drops down below their nose, you can steer clear of them; and 4) it should take less time than dinner out. At a restaurant, you’re stuck at that table. If a party near you is having an animated conversation, they could be generating a lot of respiratory secretions.

Some interesting studies have looked at the airflow and air currents in restaurants in relation to where people became infected. In one, a person was 20 feet away from the source for only about 5 minutes, but the person was directly in the airflow and became infected. It’s a reminder of what we’ve been saying—there’s nothing magical about 6 feet. The high degree of community disease in the US right now increases the likelihood that another diner in the restaurant is infected. If you are tired of cooking and need a break, takeout is the way to go.

Careful mixed with trust

Sue Mattison, Provost and Professor in the College of Pharmacy and Health Sciences, Drake University

Yes.

As an epidemiologist, my response may seem surprising or hypocritical: I do eat at local restaurants, but only because in April, like more than 17 million Americans since that time, I tested positive for COVID-19 and recovered. According to the latest evidence, I believe I have immunity for now, and perhaps longer. But I am not pushing my luck.

I have my own list of four restaurants where I eat. I trust these restaurants because each has drastically reduced their number of tables and spaced them at least 6 feet apart, and everyone inside is diligent about wearing a mask. My husband and I also order takeout a lot. It is important to reiterate, however, that evidence shows restaurants are a significant source of infection, and those who have not recovered from COVID-19 should refrain from eating at restaurants until the community gets a better handle on the spread of infection.

Short-term sacrifices

Ryan Huerto, Family Medicine Physician, Health Services Researcher and Clinical Lecturer, University of Michigan

No.

While I understand many factors contribute to indoor dining, such as the mental health toll of social isolation, the opportunity to support small businesses and cold weather, I strongly recommend against indoor dining.

The risk of contracting COVID-19 from indoor activities is far greater than from physically distanced outdoor activities. The recent spike in COVID-19 infections, deaths and ICU bed shortages is likely linked to indoor gatherings during Thanksgiving.

On December 22, 201,674 infections and 3,239 deaths due to COVID-19 were reported. This death toll is equivalent to approximately 20 Boeing 737 aircrafts crashing in a single day.

Even with a COVID-19 vaccine approved, staying home, physically distancing, wearing a mask, and good hand hygiene are as important as ever. Think of these as short-term sacrifices to help protect your friends, family, neighbors and essential workers.

Instead of dining in, please consider exponentially safer alternatives such as ordering delivery or curbside pickup.

Restaurants pose big risk

Kathleen C. Brown, Associate Professor of Practice and MPH Program Director, College of Education, Health, and Human Sciences, University of Tennessee

No.

The Centers for Disease Control and Prevention reported that patients testing positive were twice as likely to have eaten in a restaurant than those testing negative in the 14 days preceding their test. I regularly get takeout but do not eat in restaurants.

What I cannot control poses a risk. I have very open and honest conversations with family and friends about where we have been and who we have been with. From there, our risk is pretty clear but still not at zero. The more people I come into contact with, the greater the risk.

In a restaurant, I am not able to assess the risk posed by other patrons or the staff. Each person in that restaurant has a network of others that, taken together, increases my risk of contracting COVID-19. Currently, Tennessee, where I live, is the second-leading state for cases per 100,000, which means community spread is high.

In plain language, that means there is an increased likelihood that I may come into contact with someone who is infectious—symptomatic or not—if I eat inside a restaurant. I will continue to pick up my takeout for now.

The Conversation